Provider Demographics
NPI:1366437758
Name:ZIMMER, STEVEN A (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11725 STINSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHISAGO CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55013-9542
Mailing Address - Country:US
Mailing Address - Phone:651-257-8421
Mailing Address - Fax:651-257-8464
Practice Address - Street 1:11725 STINSON AVE
Practice Address - Street 2:
Practice Address - City:CHISAGO CITY
Practice Address - State:MN
Practice Address - Zip Code:55013-9542
Practice Address - Country:US
Practice Address - Phone:651-257-8421
Practice Address - Fax:651-257-8464
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN424323400Medicaid
MN4602400002Medicare NSC
MN410000085Medicare ID - Type Unspecified
MN424323400Medicaid
MN4602400003Medicare NSC
MN410001762Medicare PIN
T39665Medicare UPIN
MN4602400004Medicare NSC